scholarly journals Promoting positive interactions between midwives and obstetricians at the primary/secondary interface

2021 ◽  
Vol 57 ◽  
pp. 41-48
Author(s):  
Rachel Cassie ◽  
Christine Griffiths ◽  
George Parker
Keyword(s):  
New Zealand ◽  
Thematic Analysis ◽  
Maternity Care ◽  
Interprofessional Collaboration ◽  
Theoretical Perspective ◽  
Positive Interactions ◽  
Health Board ◽  
District Health ◽  
Interprofessional Communication ◽  
Aotearoa New Zealand

Background: Interprofessional communication is a critical component of safe maternity care. The literature reports circumstances in Aotearoa New Zealand and overseas when interprofessional collaboration works well between midwives and obstetricians, as well as descriptions of unsatisfactory communication between the two professions. Aim: To explore and define effective collaboration between midwives and obstetricians at the primary/secondary interface in maternity care, in order to generate suggestions to foster positive collaboration. Method: Eight primary care midwives, three obstetricians and two obstetric registrars from a single District Health Board in Aotearoa New Zealand were interviewed about their interactions at the primary/secondary interface and their understanding, and use, of the Referral Guidelines. The theoretical perspective was Appreciative Inquiry. Data were analysed using thematic analysis. Findings: Results indicate usually positive interprofessional interactions. Dominant emergent themes are the need to negotiate differing philosophies, to clarify blurred boundaries that sometimes lead to lack of clear lines of responsibility, and the importance of three-way conversations. Of the three themes, this article focuses on three-way communication between midwife, obstetrician/registrar and woman. Participants reported that, when effective three-way communication between woman, midwife and obstetrician occurred, philosophical difference could be negotiated, blurred boundaries clarified and understanding of the respective roles of the LMC midwife and the obstetric team promoted. Participants value the Referral Guidelines but report some limitations to their applicability. Conclusion: Effective three-way communication promotes good maternity care. This study has identified ways to support optimal communication.

Registered nurse prescribing: A descriptive survey of prescribing practices in a single district health board in Aotearoa New Zealand

2020 ◽  
Vol 36 (3) ◽  
pp. 61-72
Author(s):  
Melinda McGinty ◽  
◽  
Betty Poot ◽  
Jane Clarke ◽  
◽  
...  
Keyword(s):  
Primary Care ◽  
New Zealand ◽  
Registered Nurse ◽  
Health Conditions ◽  
Health Board ◽  
Prescribing Practices ◽  
District Health ◽  
Survey Tool ◽  
Aotearoa New Zealand ◽  
Descriptive Survey

The expansion of prescribing rights in Aotearoa New Zealand has enabled registered nurse prescribers (RN prescribers) working in primary care and specialty teams, to enhance nursing care, by prescribing medicines to their patient population. This widening of prescribing rights was to improve the population’s access to medicines and health care; however, little is known about the medications prescribed by RN prescribers. This paper reports on a descriptive survey of self-reported RN prescribers prescribing in a single district health board. The survey tool used was a Microsoft Excel spreadsheet to record nurse’s area of practice, patient demographic details, health conditions seen, and medicines prescribed and deprescribed. Simple data descriptions and tabulations were used to report the data. Eleven RN prescribers consented to take part in the survey and these nurses worked in speciality areas of cardiology, respiratory, diabetes, and primary care. Findings from the survey demonstrated that RN prescribers prescribe medicines within their area of practice and within the limits of the list of medicines for RN prescribers. Those working in primary care saw a wider range of health conditions and therefore prescribed a broader range of medications. This survey revealed that the list of medications available for RN prescribers needs to be updated regularly to align with the release of evidence-based medications on the New Zealand Pharmaceutical Schedule. It is also a useful record for both educational and clinical settings of the types of medications prescribed by RN prescribers.

scholarly journals Management of Prelabour Rupture of Membranes at Term, at Northland District Health Board.

2021 ◽  
Author(s):  
◽  
Rebecca Hay
Keyword(s):  
New Zealand ◽  
Maternity Care ◽  
Postpartum Haemorrhage ◽  
Special Care ◽  
Labour Induction ◽  
Health Board ◽  
District Health ◽  
Clinical Notes ◽  
Increased Risk ◽  
One Year

<p>Background Prelabour rupture of membranes at term (PROM) is a subject of interest to women and maternity care providers alike. Management of PROM varies internationally, and regionally within New Zealand, despite the presence of interprofessional consensus statements. Northland District Health Board (NDHB) policy differs from most maternity care facilities by enabling expectant management of labour for women at low risk of transmission of Group β Streptococcus to their baby to extend to 96 hours from time of rupture of membranes. This study aimed to explore whether the NDHB policy was applied in practice and safely served the needs of women and babies in this DHB.  Methods A retrospective quantitative clinical notes review was conducted of files in a one-year sample. The clinical notes of 123 women who had duration from ROM to birth at term of 18 hours or more were reviewed. Statistical comparisons using percentages, means and odds-ratios were made to a one-year sample of all other births at term at NDHB facilities, and with birth data from the New Zealand College of Midwives Clinical Outcomes Research Database (COMCORD).  Findings Variables including demographic data, antenatal and intrapartum care given, time factors and outcomes themselves were reviewed. Few variables impacted outcomes within the PROM sample, though use of intravenous oxytocin was associated with increased epidural use and increased incidence of instrumental birth. Wāhine Māori had an increased incidence of vaginal births but some variables and outcomes highlighted inequities, including reduced antenatal screening, a higher incidence of maternal smoking, severe postpartum haemorrhage, and admission to Special Care Baby Units. Duration splits at 48 and 96 hours were applied to identify whether time increased risks for women or babies, but duration did not appear to be a factor which increased risk. The phenomenon of PROM itself increased risk for women and babies, increasing rates of labour induction, augmentation, epidural use, operative births, postpartum haemorrhage, admission to Special Care Baby Units and decreased exclusive breastfeeding at discharge.  Conclusions The NDHB PROM policy appeared to be applied consistently and did not appear to increase risk for women and babies. Risks were increased for all women with PROM, with some inequitable outcomes for wahine Māori and pēpi. This research provides a comparison which is informative for clinical practice, education, and future research, and supports women’s involvement in decision-making.</p>

scholarly journals Management of Prelabour Rupture of Membranes at Term, at Northland District Health Board.

2021 ◽  
Author(s):  
◽  
Rebecca Hay
Keyword(s):  
New Zealand ◽  
Maternity Care ◽  
Postpartum Haemorrhage ◽  
Special Care ◽  
Labour Induction ◽  
Health Board ◽  
District Health ◽  
Clinical Notes ◽  
Increased Risk ◽  
One Year

<p>Background Prelabour rupture of membranes at term (PROM) is a subject of interest to women and maternity care providers alike. Management of PROM varies internationally, and regionally within New Zealand, despite the presence of interprofessional consensus statements. Northland District Health Board (NDHB) policy differs from most maternity care facilities by enabling expectant management of labour for women at low risk of transmission of Group β Streptococcus to their baby to extend to 96 hours from time of rupture of membranes. This study aimed to explore whether the NDHB policy was applied in practice and safely served the needs of women and babies in this DHB.  Methods A retrospective quantitative clinical notes review was conducted of files in a one-year sample. The clinical notes of 123 women who had duration from ROM to birth at term of 18 hours or more were reviewed. Statistical comparisons using percentages, means and odds-ratios were made to a one-year sample of all other births at term at NDHB facilities, and with birth data from the New Zealand College of Midwives Clinical Outcomes Research Database (COMCORD).  Findings Variables including demographic data, antenatal and intrapartum care given, time factors and outcomes themselves were reviewed. Few variables impacted outcomes within the PROM sample, though use of intravenous oxytocin was associated with increased epidural use and increased incidence of instrumental birth. Wāhine Māori had an increased incidence of vaginal births but some variables and outcomes highlighted inequities, including reduced antenatal screening, a higher incidence of maternal smoking, severe postpartum haemorrhage, and admission to Special Care Baby Units. Duration splits at 48 and 96 hours were applied to identify whether time increased risks for women or babies, but duration did not appear to be a factor which increased risk. The phenomenon of PROM itself increased risk for women and babies, increasing rates of labour induction, augmentation, epidural use, operative births, postpartum haemorrhage, admission to Special Care Baby Units and decreased exclusive breastfeeding at discharge.  Conclusions The NDHB PROM policy appeared to be applied consistently and did not appear to increase risk for women and babies. Risks were increased for all women with PROM, with some inequitable outcomes for wahine Māori and pēpi. This research provides a comparison which is informative for clinical practice, education, and future research, and supports women’s involvement in decision-making.</p>

scholarly journals Modeling the Costs of Hospital-Acquired Infections in New Zealand

2003 ◽  
Vol 24 (3) ◽  
pp. 214-223 ◽  
Author(s):  
Nicholas Graves ◽  
Tanya M. Nicholls ◽  
Arthur J. Morris
Keyword(s):  
New Zealand ◽  
Economic Cost ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Primary Data ◽  
Health Board ◽  
District Health ◽  
Hospital Acquired Infections ◽  
Input Variables ◽  
Hospital Acquired

AbstractObjective:To model the economic costs of hospital-acquired infections (HAIs) in New Zealand, by type of HAI.Design:Monte Carlo simulation model.Setting:Auckland District Health Board Hospitals (DHBH), the largest publicly funded hospital group in New Zealand supplying secondary and tertiary services. Costs are also estimated for predicted HAIs in admissions to all hospitals in New Zealand.Patients:All adults admitted to general medical and general surgical services.Method:Data on the number of cases of HAI were combined with data on the estimated prolongation of hospital stay due to HAI to produce an estimate of the number of bed days attributable to HAI. A cost per bed day value was applied to provide an estimate of the economic cost. Costs were estimated for predicted infections of the urinary tract, surgical wounds, the lower and upper respiratory tracts, the bloodstream, and other sites, and for cases of multiple sites of infection. Sensitivity analyses were undertaken for input variables.Results:The estimated costs of predicted HAIs in medical and surgical admissions to Auckland DHBH were $10.12 (US $4.56) million and $8.64 (US $3.90) million, respectively. They were $51.35 (US $23.16) million and $85.26 (US $38.47) million, respectively, for medical and surgical admissions to all hospitals in New Zealand.Conclusions:The method used produces results that are less precise than those of a specifically designed study using primary data collection, but has been applied at a lower cost. The estimated cost of HAIs is substantial, but only a proportion of infections can be avoided. Further work is required to identify the most cost-effective strategies for the prevention of HAI.

scholarly journals Community Governance and Civil Society: An Examination of the Purpose, Intent and Structure of Residents' Groups in New Zealand

2021 ◽  
Author(s):  
◽  
Jarrod Coburn
Keyword(s):  
New Zealand ◽  
News Media ◽  
Local Community ◽  
Political Activity ◽  
Health Board ◽  
District Health ◽  
Community Governance ◽  
Set Up ◽  
Civil Defence ◽  
Charitable Activities

<p>Residents’ groups have been in existence in New Zealand for almost 150 years yet very little is known about them. The collection of residents’, ratepayers’ and progressive associations, community councils, neighbourhood committees and the like make up a part of the community governance sector that numbers over a thousand-strong. These groups are featured prominently in our news media, are active in local government affairs and expend many thousands of volunteer hours every year in their work in communities… but what exactly is that work? From the literature we see these groups can be a source of local community knowledge (Kass et al., 2009), a platform for political activity (Deegan, 2002), critical of government (Fullerton, 2005) or help maintain government transparency and accountability (Mcclymont and O'Hare, 2008). They are sometimes part of the establishment too (Wai, 2008) and are often heard promoting the interests of local people (Slater, 2004). Residents’ groups can be set up to represent the interests of a specific demographic group (Seng, 2007) or focus on protecting or promoting a sense of place (Kushner and Siegel, 2003) or physical environment (Savova, 2009). Some groups undertake charitable activities (Turkstra, 2008) or even act in a negative manner that can impact on the community (Horton, 1996). This research examines 582 New Zealand organisations to derive a set of purposes that residents’ groups perform and ascertains how their purposes differ between geo-social and political locality and over three distinct eras of community development. The thesis also examines the relationship between residents’ groups and councillors, council officers, district health board members and civil defence and seeks to uncover if the level of engagement (if any) has an affect on their overall raison d’etre. The research concludes with a typology of New Zealand residents’ groups along with the key purposes of each type.</p>

scholarly journals Use of aspirin and statins for cardiovascular risk reduction in New Zealand: The residential care story

2009 ◽  
Vol 1 (3) ◽  
pp. 184 ◽  
Author(s):  
Jae Bon Hoem ◽  
Ngaire Kerse ◽  
Shane Scahill ◽  
Simon Moyes ◽  
Charlotte Chen ◽  
...  
Keyword(s):  
New Zealand ◽  
General Practitioners ◽  
Residential Care ◽  
Prescribing Patterns ◽  
Health Board ◽  
District Health ◽  
Cardiovascular Risk Reduction ◽  
Residential Care Facilities ◽  
Care Facilities ◽  
Social Debate

INTRODUCTION : Cardiovascular disease (CVD) is one of the leading causes of morbidity and mortality for older New Zealanders. Medication prescribing for secondary prevention of cardiovascular events in residential care is unknown and prescribing patterns for aspirin and statins by general practitioners (GPs) in residential care facilities in Auckland, New Zealand are reported here. METHODS: A representative sample of residential care facilities, all residents over age 65 years and their GPs in one district health board region in Auckland were recruited. Prescribing and medical records were audited by a trained nurse and medications coded into classes according to a standardised process. Diagnoses from summary sheets and hospital letters were recorded. Descriptive statistics were used to show variability in proportion of residents prescribed aspirin and statins. RESULTS: Of a total of 24 facilities approached, 14 consented to participate (58%); 537 residents (88% of eligible) agreed to participate and 533 completed the study. Residents took on average 8.3 (standard deviation 2.4) medications. On average 2.64 (range 1–6) GPs serviced each facility with eight GPs working in more than one facility. On average 54% of residents with documented CVD were prescribed aspirin and 31% of those with CVD and/or dyslipidaemia were prescribed statins. Variability between prescribers and facilities was high. DISCUSSION: Prescribing in residential care does not appear to be guidelines-based. The reasons for this are unknown. Ongoing social debate about the role of prevention for older people and interventions for GPs and residential care facilities may impact prescribing rates. KEYWORDS: Cardiovascular diseases; residential care; aspirin; statins; prescribing patterns; general practitioners

Malnutrition risk of older people across district health board community, hospital and residential care settings in New Zealand

2017 ◽  
Vol 36 (3) ◽  
pp. 205-211 ◽  
Author(s):  
Carol Wham ◽  
Emily Fraser ◽  
Julia Buhs-Catterall ◽  
Rebecca Watkin ◽  
Cheryl Gammon ◽  
...  
Keyword(s):  
New Zealand ◽  
Older People ◽  
Residential Care ◽  
Community Hospital ◽  
Health Board ◽  
District Health

scholarly journals The Prevalence and Estimates of the Cumulative Incidence of Hospital-Acquired Infections Among Patients Admitted to Auckland District Health Board Hospitals in New Zealand

2003 ◽  
Vol 24 (1) ◽  
pp. 56-61 ◽  
Author(s):  
Nicholas Graves ◽  
Tanya M. Nicholls ◽  
Christopher G. S. Wong ◽  
Arthur J. Morris
Keyword(s):  
New Zealand ◽  
Cumulative Incidence ◽  
Cost Effective ◽  
Point Prevalence ◽  
Health Board ◽  
District Health ◽  
Hospital Acquired Infection ◽  
Hospital Acquired Infections ◽  
Incidence Studies ◽  
Hospital Acquired

AbstractObjectives:To report the pooled results of seven prevalence surveys of hospital-acquired infections conducted between November 1996 and November 1999, and to use the data to predict the cumulative incidence of hospital-acquired infections in the same patient group.Design:The summary and modeling of data gathered from the routine surveillance of the point prevalence of hospital-acquired infections.Setting:Auckland District Health Board Hospitals (Auckland DHBH), the largest publicly funded hospital group in New Zealand supplying secondary and tertiary services.Patients:All inpatients.Method:Point-prevalence surveys were conducted including all patients in Auckland DHBH. Standard definitions of hospital-acquired infection were used. The data from the seven surveys were pooled and used in a modeling exercise to predict the cumulative incidence of hospital-acquired infection. An existing method for the conversion of prevalence to cumulative incidence was applied. Results are presented for all patients and stratified by clinical service and site of hospital-acquired infection.Results:The underlying patterns of hospital-acquired infection by site and service were stable during the seven time periods. The prevalence rate for all patients was 9.5%, with 553 patients identified with one or more hospital-acquired infections from a population of 5,819. The predicted cumulative incidence for all patients was 6.33% (95% confidence interval, 6.20% to 6.46%).Conclusions:The prevalence and the predicted cumulative incidence are similar to rates reported in the international literature. The validity of the predicted cumulative incidence derived here is not known. If it were accurate, then the application of this method would represent a cost-effective alternative to incidence studies.

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